Posts Tagged ‘qualifying for free behavioral health medication’

Behavioral Health Medicine Transition Update

September 9th, 2010

As you recall, the ADHS budget reduction last fiscal year required us to scale back the services we provide to folks who were receiving behavioral health services but don’t qualify for AHCCCS (called Non-Title XIX).  We also needed to switch to a “generic formulary” for Non-Title XIX folks on July 1 (which saves about $7M/year).  We had initially intended to implement the generic formulary on July 1, 2010, but as that date approached, it became clear that some individuals needed more time to ensure that patients could be safely transitioned, so we modified our guidance document to allow the transition of remaining members by October 1, 2010.

We also added one name brand medication called Risperidal Consta, a long-acting injectable antipsychotic medication, to the formulary.  There are numerous class equivalent antipsychotic medications still on the formulary to choose from as an alternative to the remaining name brand med’s, including long-acting injectables like Haldol Decanoate and Prolixin Decanoate. (As an aside, our TXIX formulary is among the most robust in the nation).

We’ve also asked our Regional Behavioral Health Authorities (RBHA) & Providers to have their doctors and patients apply for the pharmaceutical Patient Assistance Program if they or their patient believe a brand name med that has no substitute and is not on the formulary.  We developed tips for accessing brand name meds to help streamline the process.  We have been getting feedback that many individuals have been successful getting on Patient Assistance Programs.

If the patient doesn’t qualify for a pharmacy Patient Assistance Program (usually because of income), we’ve asked the RBHAs to make sure the patient knows about the new Pre-existing Condition Insurance Plan, which they may be able to afford.  We also encourage the RBHAs to help patients apply for a medication discount card so they can get medicine at a reduced rate.   Also, doctors may be able to obtain samples from the pharmaceutical company and provide those to patients at their discretion.

We’ve been conservative in our financial modeling and projections to make sure we avoid the need to cap enrollment and wait list new members later in the fiscal year.   We’ll continue to carefully examine our Non-Title XIX expenses as the first quarter progresses.  We’d like to expand the formulary to include additional name brand meds if we can later in the fiscal year, but our top priority is to make sure we avoid an enrollment cap toward the end of the fiscal year.

Behavioral Health Service “Conversions”

June 3rd, 2010

As I’ve mentioned in previous updates, the service package for folks with serious mental illnesses that don’t qualify for our state Medicaid program (AHCCCS) is being reduced beginning July 1 because of budget reductions.  As a result, it’s more important than ever to make sure that everybody that may qualify has the opportunity top get Medicaid benefits (the more robust service package).  That’s why we’ve been pressing our contractors (regional behavioral health authorities (RBHAs)) to canvass as many people as possible in case they qualify for the full benefit package.  All of the RBHAs have been making these efforts- but I thought I’d give you an example of what’s been happening in the Valley.

2009 Screening

As an example of what some of the contractors are doing…  last spring and summer Magellan completed an  organized AHCCCS eligibility screening initiative that increased enrollment from 52% to 61%.  They screened 75% of the folks that hadn’t yet qualified and successfully converted 1,541 to Medicaid eligibility, found that another 2,623 were eligible (pending an application), 1,258 were potentially eligible (application pursued) and that  2,249 (37%) were financially ineligible for enrollment in Medicaid.

2010 Screening

Following the 2009 screening initiative, they better integrated routine screening of people that weren’t enrolled in AHCCCS and began a second effort to re-screen folks for Medicaid.  As of last week, 72% (6,070) of the folks  had been screened (along with other transition service work). In this most recent screening, 880 of those screened (11%) were successfully enrolled.  These efforts are on-going.

Administrative Conversion Efforts

We’re encouraging our RBHAs to use the subscription version of the Health-e-Arizona website at https://www.healthearizona.org/app/Default.aspx, which walks applicants through the application process and provides assistance on how to submit necessary documents (i.e., social security card) and prints bar coded fax cover sheets that tie back to the application so documents are not lost in the submission process.  It also does a cross-check with other benefit programs and lets applicants know if they might qualify for other programs. As of this week, all of the RBHAs have either signed up for the subscription service or have responded and are on their way.

For example, Magellan amended their contracts earlier this year to pay for 25 new eligibility specialists for the clinic sites to track & convert when possible.  They started using the subscription Health-e Arizona service last summer at some of their sites and are now adding 60 individual subscription licenses to bring the total available to 75. Each of the clinic sites are designating key Health-e Arizona staff experts who will receive orientation Friday (June 4).